Provider Demographics
NPI:1467571018
Name:GODWIN, JACOB PAUL (EAMP, LAC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PAUL
Last Name:GODWIN
Suffix:
Gender:M
Credentials:EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201
Mailing Address - Country:US
Mailing Address - Phone:509-638-0808
Mailing Address - Fax:509-232-3588
Practice Address - Street 1:1625 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-638-0808
Practice Address - Fax:509-232-3588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60129504171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist